Provider Demographics
NPI:1134684467
Name:FEDEROWICZ, VIVIAN BARBOUR (DC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:BARBOUR
Last Name:FEDEROWICZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:ANN
Other - Last Name:BARBOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9116 DEERSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4099
Mailing Address - Country:US
Mailing Address - Phone:919-820-2201
Mailing Address - Fax:
Practice Address - Street 1:7530 RAMBLE WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4315
Practice Address - Country:US
Practice Address - Phone:919-790-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4788111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor